Understanding contrasting approaches to nationwide implementations of electronic health record systems: England, the USA and Australia

Zoe Morrison*, Ann Robertson, Kathrin Cresswell, Sarah Crowe, Aziz Sheikh

*Corresponding author for this work

Research output: Contribution to journalArticle

45 Citations (Scopus)

Abstract

As governments commit to national electronic health record (EHR) systems, there is increasing international interest in identifying effective implementation strategies. We draw on Coiera's typology of national programmes - 'top-down', 'bottom-up' and 'middle-out' - to review EHR implementation strategies in three exemplar countries: England, the USA and Australia. In comparing and contrasting three approaches, we show how different healthcare systems, national policy contexts and anticipated benefits have shaped initial strategies. We reflect on progress and likely developments in the face of continually changing circumstances. Our review shows that irrespective of the initial strategy, over time there is likely to be convergence on the negotiated, devolved middle-out approach, which aims to balance the interests and responsibilities of local healthcare constituencies and national government to achieve national connectivity. We conclude that, accepting the current lack of empirical evidence, the flexibility offered by the middle-out approach may make this the best initial national strategy.

Original languageEnglish
Pages (from-to)25-42
Number of pages18
JournalJournal of Healthcare Engineering
Volume2
Issue number1
DOIs
Publication statusPublished - Mar 2011

Keywords

  • electronic health records
  • implementation
  • information technology
  • international approaches

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